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The toilet is a magnificent thing. Invented at the turn of the 19th century, the flush version has vastly improved human life.

The toilet has been credited with adding a decade to our
longevity. The sanitation system to which it is attached was voted the
greatest medical advance in 150 years by readers of the British Medical
Journal.

Unfortunately, it is an impractical luxury for
about two-thirds of the world's seven billion people because it relies
on connections to water and sewerage systems that must be built and
maintained at great expense.

About 40 per cent of all
people, an estimated 2.6 billion of them, have no access to even a
minimally sanitary facility, according to the World Health Organization
(WHO).

The result is illness and early death. Diarrhoeal
diseases, including those linked to improper sanitation, are the
second-largest killer in the developing world, taking two million lives
annually.

A cholera outbreak in Haiti, which has so far
killed more than 7,000, apparently began when sewage from a base housing
Nepalese peacekeepers contaminated a water source.

NEW DESIGNS REQUIRED

Vaccines and medicines against these diseases help. But the
ultimate solution is to address the problem at its root, and doing so
requires reimagining the toilet. New designs are required for toilets
that are hygienic, pleasant and cheap to make and use, and that work
without being connected to a grid.

As such a facility would
have to be periodically emptied, ideally excretions should be treated
not as waste but either recycled on site or turned into profitable
resources.

Among the designs being developed by eight
university teams funded by the Bill & Melinda Gates Foundation are
several that divert and capture urine, from which water can be
recovered. Others produce energy by turning excrement into charcoal or
gas.

The Gates Foundation requires that the overall cost of a future
toilet, including maintenance, should not exceed 5 US cents (6.3
Singapore cents) a user a day - a price developing-world consumers can
afford. That would enable the private sector to step up production and
distribution once practical new models have emerged.

Cities would have to build a new generation of waste-processing centres, but the investment would quickly pay for itself.

ADVOCACY EFFORTS NEEDED

A WHO study suggests that every dollar devoted to improving
sanitation and drinking water produces economic benefits ranging from
US$3 to US$34 because of healthcare savings, deaths averted, and
improved productivity and school attendance.

As operating a
toilet will cost individuals a little money, the uninitiated - the 1.1
billion people who defecate in the open - will have to be persuaded of
the benefits. This will require huge education and advocacy efforts, for
which United Nations agencies and non-government organisations that
deal with the world's poor have proved to be well-suited, based on their
rollout of HIV drugs, for instance.

For gridless
sanitation to be economical, commerce needs to flourish around the
collection and treatment of excrement. Government agencies and
charitable business associations could help by offering local businesses
small grants, loans and expert guidance to encourage this enterprise.

One model is the US-based Acumen Fund, which offers loans to, or
equity in, companies that provide consumers in the developing world with
essential needs. In 2004, the fund invested US$600,000 in WaterHealth
International, established to bring safe drinking water to rural
Indians, and today the company serves more than five million people.

EMBRACING SANITATION

More than anything, these potentially helpful actors must go
beyond recognising sanitation as an issue and embrace it. So far,
squeamishness has been an impediment. As a result, other public-health
causes have claimed greater attention and funding.

According to an annual report by the George Institute for Global Health,
of the money spent on research and development of new products for
diseases that disproportionately affect the developing world, AIDS
accounts for 39 per cent, malaria 18 per cent and tuberculosis 15 per
cent.

Diarrhoeal diseases get 5 per cent, though they cause
more morbidity and mortality than anything but lower respiratory
infections, mostly pneumonia (which attracts a lousy 3 per cent of the
research total).

Bad sanitation is a problem not so hard to
solve, if only we devote ourselves to spreading the wonders of the
toilet.